平板运动试验结合动态心电图对冠心病的诊断价值

Diagnostic value of treadmill exercise test combined with 24 h dynamic electrocardiogram in patients with coronary heart disease

目的探讨24h动态心电图（DCG）及平板运动试验（TET）在冠心病诊断中的应用，并对冠状动脉造影（CAG）与平板运动试验相关指标进行分析。方法选择有不典型胸痛或可疑冠心病患者149例，在CAG前行DCG和TET检查，分析DCG及TET两种检查方法各自对冠心病的诊断价值，以及两者联合对冠心病的诊断价值，并根据CAG的结果分为冠心病组和非冠心病组，记录TET运动开始后第1分钟心率的增加量（△HR1min）及运动后收缩压（SBP）恢复等指标，与冠状动脉造影结果相比较。结果DCG诊断冠心病的敏感性为61．90％，特异性：为66．15％；TET诊断冠心病的敏感性为78．57％，特异性为70．77％；两者联合并联试验时敏感性为95．23％，特异性为55．38％，阳性预测值为73．39％，阴性预测值为90．00％；敏感性、阴性预测值较单独DCG、TET提高；两者联合串联试验时敏感性为52．38％，特异性为95．38％，阳性预测值为93．62％，阴性预测值为60．78％，特异性、阳性预测值较单独DCG、TET提高；冠心病患者男性比例高于非冠心病组[72例（85．71％）与35例（53．85％），χ^2=18．385，P〈0．01]，收缩压恢复比异常增高[46．43％（39／84）与15．38％（10／65），χ^2=16．001，P〈0．01]。结论DCG与TET两者结合可提高对冠心病诊断的敏感性和特：异性，冠心病组患者运动后收缩压恢复延迟，该指标可作为冠心病诊断的辅助标准。

Objective To evaluate the value of 24 h dynamic electrocardiogram（DCG） and treadmill exercise testing（TET） in diagnosing coronary heart disease（ CHD）, and analyze relevant index between coronary arteriography（CAG） and treadmill exercise testing. Methods One hundred and forty-nine borderline cases of coronary heart disease were enrolled. Every patient was examined by DCG, TET, and CAG, compared the diagnostic value of TET combined with DCG and TET or DCG alone, and record the increased heart rate during the first minute （ △ HR1 min） of TET and systolic blood pressure （SBP）recovery. The patients were divided into a CHD group and a non-CHD group according to the results of coronary angiography. Results The sensitivity rate was 78.57% and specific rate was 70.77% by means of TET. The sensitivity rate was 61.90% and specific rate was 66. 15% by means of DCG. The sensitivity rate was 95.23% , specific rate was 55.38%, positive predictive value was 73.39% and negative predictive value was 90. 00% by parallel way of DCG and TET, its sensitivity rate （95.23%） and negative predictive value （90. 00% ） were more than those of DCG or TET alone. The sensitivity rate was 52. 38%, specific rate was 95.38%, positive predictive value was 93.62% and negative predictive value was 60. 78% by serial way of DCG and TET,its specific rate （95.38%） and positive predictive value （93.62%） were more than those of DCG or TET alone. The number of men in the CHD group was higher than the number of women. Ratio of systolic blood pressure recovery（rSBPR） in the CHD group was significantly higher than that in the non-CHD group （ P 〈 0. 01 ）. Conclusion It can obviously enhance the sensitivity rate and specific rate if combined TET with DCG. Patients with CHD have a delayed decline in SBP during recovery which can be one of the indexes to estimate the extent of myocardial isehemia and coronary artery lesion.